# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS)

## Subtitle 08 — Designation of Trauma and Specialty Referral Centers

### Chapter 13 — Disciplinary Action for Violation of Subtitle

**Authority:** Education Article, §13-509, Annotated Code of Maryland

**Administrative History:** Effective date: March 24, 1997 (24:6 Md. R. 488)

**Administrative History:** Regulations .01—.06 amended effective July 1, 2002 (29:12 Md. R. 934)

**Administrative History:** Regulation .03C, D amended effective December 19, 2005 (32:25 Md. R. 1947); October 12, 2015 (42:20 Md. R. 1265)

#### Regulation .01 Grounds for Disciplinary Action.

*COMAR 30.08.13.01*

MIEMSS may take disciplinary action against a designated trauma or specialty referral center if the trauma or specialty referral center:

A. Is out of compliance with the requirements of this subtitle, and has been unable or has refused to comply as required by MIEMSS;

B. Fails to comply with, or otherwise violates the provisions of, State or federal law;

C. Fails to provide data to MIEMSS, as required by COMAR 30.08.03.01;

D. Makes a false statement or omits a material fact in:

  (1) Its application for designation,

  (2) A record required by this subtitle, or

  (3) A matter under investigation;

E. Prevents, interferes with, or attempts to impede in any way, the work of a representative of MIEMSS in the lawful enforcement of this subtitle or any other applicable State law;

F. Uses false, fraudulent, or misleading advertising, or makes any public claims regarding the center's ability to care for nontrauma or nonspecialty care patients based on its trauma or specialty referral center designation status; or

G. Fails to cooperate in providing documentation and interviews with appropriate staff for MIEMSS' investigation of complaints.

#### Regulation .02 Preliminary and Further Investigations.

*COMAR 30.08.13.02*

A. Receipt of Information.

  (1) MIEMSS shall initiate a preliminary investigation if it receives information that might form the basis for action against a trauma or specialty referral center.

  (2) A person may file a signed, written complaint with the Office of Hospital Programs regarding an alleged violation of this subtitle.

  (3) MIEMSS may begin an investigation without a signed written complaint if it determines that sufficient cause exists.

B. MIEMSS may initiate a further investigation if it needs additional information to determine whether disciplinary action is warranted.

C. Not later than 10 business days after MIEMSS decides to begin an investigation, MIEMSS shall give written notice of the investigation to the trauma or specialty referral center being investigated, unless extenuating circumstances exist that would reasonably preclude notification.

D. At the conclusion of MIEMSS' investigation, MIEMSS shall report its findings, in writing, to the chief executive officer of the trauma or specialty referral center, including requirements for corrective action, if MIEMSS determines that corrective action is appropriate.

#### Regulation .03 Confidentiality of Records of Investigation.

*COMAR 30.08.13.03*

A. MIEMSS shall take reasonable precautions to ensure that an investigation is conducted in a confidential manner.

B. MIEMSS shall maintain a record for each designated trauma and specialty referral center in Maryland.

C. If MIEMSS begins an investigation, it shall create a confidential record containing the investigatory material, which:

  (1) Is exempt from disclosure under Health Occupations Article, §§1-401 and 14-506, Annotated Code of Maryland, and General Provisions Article, Title 4, Subtitle 3, Annotated Code of Maryland; and

  (2) Shall be placed in the designated trauma or specialty referral center's official record.

D. A request for records maintained by MIEMSS shall be processed under Health Occupations Article, §§1-401 and 14-506, Annotated Code of Maryland, and General Provisions Article, Title 4, Subtitle 3, Annotated Code of Maryland.

#### Regulation .04 Finding of Violation.

*COMAR 30.08.13.04*

If MIEMSS finds that a trauma or specialty referral center has violated this subtitle, MIEMSS may:

A. Require a trauma or specialty referral center to submit a plan of corrective action;

B. Place a designated trauma or specialty referral center on probation;

C. Lower a trauma center's level of designation;

D. Suspend a trauma or specialty referral center's designation; or

E. Revoke a trauma or specialty referral center's designation.

#### Regulation .05 Plan of Corrective Action.

*COMAR 30.08.13.05*

A. If MIEMSS requires a trauma or specialty referral center to submit a plan of corrective action, the notice required by Regulation .02D of this chapter shall include a deadline for submission of the plan of corrective action by the trauma or specialty referral center.

B. The plan shall include:

  (1) Steps that the trauma or specialty referral center intends to take to correct deficiencies; and

  (2) The projected date of completion.

C. Not later than 15 business days after it receives the plan, MIEMSS shall:

  (1) Decide whether to approve the plan; and

  (2) Provide written notice of its decision to the trauma or specialty referral center.

D. If MIEMSS disapproves the plan, not later than 15 business days from the date of disapproval, the trauma or specialty referral center may request an informal meeting in accordance with Regulation .06D of this chapter.

E. If MIEMSS approves the plan of correction, the trauma or specialty referral center shall:

  (1) Begin implementation of the plan immediately upon receiving notice of approval; and

  (2) Notify MIEMSS upon completion of the plan.

F. Review of Compliance with Plan.

  (1) MIEMSS may conduct an on-site review to determine whether the trauma or specialty referral center has complied with the plan of correction.

  (2) If MIEMSS determines that the trauma or specialty referral center has satisfactorily complied with the plan, the trauma or specialty referral center shall retain its designation status.

  (3) If MIEMSS determines that the trauma or specialty referral center has not satisfactorily complied with the plan, MIEMSS may take further disciplinary action against the trauma or specialty referral center under Regulation .06 of this chapter.

#### Regulation .06 Procedures for Disciplinary Actions.

*COMAR 30.08.13.06*

A. MIEMSS shall initiate an action to place a trauma or specialty referral center on probation or to lower, suspend, or revoke a trauma or specialty referral center's designation if MIEMSS:

  (1) Determines that the violation warrants probation, lowered level of designation, suspension, or revocation; or

  (2) Has required a plan of corrective action, and:

    (a) The trauma or specialty referral center fails to submit a plan within the time set by MIEMSS, or

    (b) MIEMMS determines that the trauma or specialty referral center has not satisfactorily complied with the plan.

B. Notice of Action.

  (1) MIEMSS shall notify a trauma or specialty referral center of the disciplinary action by issuing a written notice of suspension, revocation, lowered level of designation, or probation to the chief executive officer of the hospital.

  (2) The notice of suspension, revocation, lowered level of designation, or probation shall conform to State Government Article, §10-207, Annotated Code of Maryland.

  (3) MIEMSS shall notify the EMS Board of the action taken.

C. Except in the case of an emergency suspension or revocation under §F of this regulation, the suspension, revocation, lowered level of designation, or probation is stayed pending the final agency decision.

D. Informal Meeting.

  (1) Not later than 15 business days from the date a trauma or specialty referral center receives a notice of suspension, revocation, lowered level of designation, or probation, the trauma or specialty referral center may request, in writing, an informal meeting with MIEMSS to discuss MIEMSS' action.

  (2) The meeting shall be held not later than 10 business days from the date MIEMSS receives the request.

  (3) If the trauma or specialty referral center does not timely request an informal meeting, MIEMSS' notice of suspension, revocation, lowered level of designation, or probation is the final agency decision.

E. Request for Hearing.

  (1) This section does not apply to an emergency revocation or suspension hearing under §F of this regulation.

  (2) If the trauma or specialty referral center is not satisfied with the result of the informal meeting, not later than 15 business days from the date of the meeting, it may request a hearing by sending a written request for a hearing by certified mail, return receipt requested, addressed to the MIEMSS Office of Hospital Programs in Baltimore, Maryland.

  (3) Not later than 5 business days from the date of receipt of a timely request for a hearing, MIEMSS shall forward the request to OAH.

  (4) From the date OAH receives the hearing request, OAH shall schedule a hearing as soon as practicable for all parties and OAH, but not later than:

    (a) 60 calendar days for temporary suspensions or revocations; or

    (b) 90 calendar days for all other hearings.

  (5) The hearing is conducted in accordance with the procedures set forth in §G of this regulation.

  (6) If the trauma or specialty referral center does not request a hearing in a timely manner, MIEMSS' notice of suspension, revocation, lowered level of designation, or probation is the final agency decision.

F. Emergency Revocation or Suspension.

  (1) If MIEMSS determines that grounds exist that require immediate suspension or revocation of designation for the public's protection, MIEMSS may issue a notice of immediate suspension or revocation of designation to the chief executive officer of the trauma or specialty referral center.

  (2) The suspension or revocation of designation is effective immediately upon service of the notice of immediate suspension or revocation of designation.

  (3) Request for Hearing.

    (a) Not later than 15 business days after service of the notice of immediate suspension or revocation of designation, the trauma or specialty referral center may request a hearing by sending a written request for a hearing by certified mail, return receipt requested, addressed to the MIEMSS Office of Hospital Programs in Baltimore, Maryland.

    (b) Requesting a hearing does not negate, or act as a stay of, the suspension or revocation.

    (c) If the trauma or specialty referral center does not request a hearing in a timely manner, MIEMSS' notice of immediate suspension or revocation of designation is the final agency decision.

  (4) Upon receipt of a hearing request, MIEMSS shall send a written request to OAH to schedule a hearing.

  (5) OAH shall conduct the hearing within 10 business days of the date it receives the hearing request, except that the time period may be extended by:

    (a) OAH for good cause; or

    (b) Agreement of the trauma or specialty referral center and MIEMSS.

  (6) Except as modified in this section, the hearing shall be conducted in accordance with the procedures set forth in §G of this regulation.

  (7) Not later than 10 business days after the close of the hearing record, OAH shall issue a proposed decision that includes proposed findings of fact and conclusions of law and a proposed order, except that the time period may be extended by:

    (a) OAH for good cause; or

    (b) Agreement of the trauma or specialty referral center and MIEMSS.

  (8) Appeal to the EMS Board.

    (a) Filing of Exceptions.

      (i) Not later than 5 business days from the date it receives the proposed decision, a party aggrieved by the proposed decision may appeal by filing written exceptions with the Executive Director, for consideration by the EMS Board.

      (ii) The exceptions shall state with specificity the reasons why the proposed decision should be overturned.

      (iii) A party filing exceptions may request an oral argument and shall submit the request with the exceptions.

      (iv) A party filing exceptions shall mail a copy of its exceptions to the opposing party by first class mail, postage prepaid.

      (v) If exceptions are not filed within the specified time period, the OAH proposed decision is the final agency decision.

    (b) Response to Exceptions.

      (i) Not later than 5 business days after the opposing party receives a copy of the exceptions, the opposing party may file a response with the EMS Board.

      (ii) A party filing a response may request an oral argument and shall submit the request with the response.

      (iii) A party filing a response shall mail a copy of its response to the party filing exceptions by first class mail, postage prepaid.

    (c) Decision of EMS Board.

      (i) Not later than 30 calendar days after the filing of the exceptions or the response, whichever is later, the EMS Board shall issue a written decision granting or denying the exceptions.

      (ii) The EMS Board may, in its discretion, rule on the exceptions with or without oral argument.

    (d) If the EMS Board denies the exceptions, the proposed decision, as affirmed by the EMS Board, is the final agency decision.

    (e) If the EMS Board grants the exceptions, in whole or in part, the EMS Board shall modify the proposed decision accordingly and the modified decision is the final agency decision.

    (f) The EMS Board shall issue its final decision in accordance with State Government Article, §§10-220 and 10- 221, Annotated Code of Maryland.

  (9) A party aggrieved by a final agency decision may seek judicial review in accordance with State Government Article, §10-222, Annotated Code of Maryland, and the Maryland Rules of Civil Procedure.

G. Hearing Procedures.

  (1) A hearing shall be conducted in accordance with the procedures and regulations of OAH set forth in COMAR 28.02.01, except as modified by this regulation.

  (2) Confidential Materials Not Discoverable.

    (a) In addition to the restrictions on discovery of documents under COMAR 28.02.01.10, a party is not entitled to discovery of any confidential:

      (i) Record;

      (ii) File;

      (iii) Memorandum;

      (iv) Correspondence;

      (v) Document;

      (vi) Object; or

      (vii) Other tangible thing.

    (b) For purposes of this regulation, all records, files, memoranda, correspondence, documents, objects, other tangible things, notes, minutes of conferences, and any other communications of members of an on-site review team are confidential.

    (c) This subsection does not restrict the rights of:

      (i) MIEMSS to obtain any information to which it is entitled under this subtitle; and

      (ii) A hospital to information originating from the hospital's files.

  (3) In a proceeding before an administrative law judge or a court:

    (a) MIEMSS may disclose information or present evidence that contains or might reveal confidential information if the information is relevant to the case; and

    (b) If there is an objection, before the information is disclosed, the administrative law judge or court that is conducting the proceeding shall determine whether the information is confidential and, if it is, enter an order that it determines is appropriate to protect the confidentiality of the information.

  (4) MIEMSS has the burden of proving, by a preponderance of the evidence, the grounds for suspension, revocation, lowered level of designation, or probation.

  (5) Except for an emergency suspension or revocation under §F of this regulation, not later than 60 business days after the close of the hearing, OAH shall issue a proposed decision that shall include proposed findings of fact and conclusions of law and a proposed order.

H. Appeal to the EMS Board.

  (1) This section does not apply to an emergency revocation or suspension under §F of this regulation.

  (2) Filing of Exceptions.

    (a) Not later than 15 business days from the date it receives the proposed decision, a party aggrieved by the proposed decision may appeal by filing written exceptions with the Executive Director, for consideration by the EMS Board.

    (b) The exceptions shall state with specificity the reasons why the proposed decision should be overturned.

    (c) A party filing exceptions may request an oral argument and shall submit the request with the exceptions.

    (d) A party filing exceptions shall mail a copy of its exceptions to the opposing party by first class mail, postage prepaid.

    (e) If exceptions are not filed within the specified time period, the proposed decision is the final agency decision.

    (f) Response to Exceptions.

      (i) Not later than 15 business days from the date of the filing of the exceptions with the EMS Board, the opposing party may file a response with the EMS Board.

      (ii) A party filing a response may request an oral argument and shall submit the request with the response.

      (iii) A party filing a response shall mail a copy of its response to the party filing exceptions by first class mail, postage prepaid.

  (3) Decision of EMS Board.

    (a) The EMS Board may, in its discretion, rule on the exceptions with or without oral argument.

    (b) If the EMS Board denies the exceptions, in whole or in part, the proposed decision is the final agency decision.

    (c) If the EMS Board grants the exceptions, the EMS Board shall modify the proposed decision accordingly and the modified decision is the final agency decision.

    (d) The EMS Board shall issue its final decision in accordance with State Government Article, §§10-220 and 10- 221, Annotated Code of Maryland.

I. A party aggrieved by a final agency decision of the EMS Board may seek judicial review in accordance with State Government Article, §10-222, Annotated Code of Maryland, and the Maryland Rules of Civil Procedure.